In considering treatment options for alcohol abuse, dependence, or addiction you will have first decided between inpatient and outpatient. Except in very rare cases outpatient is your best choice: it is cost effective, minimally disruptive, has continuity, and can adapt to your changing circumstances and needs (see Alcohol Abuse Treatment - Inpatient or Outpatient?). But having decided this question you are left with a confusing number of choices.

It's hard to make any choice at a time when every decision seems overwhelming. It's also tough when you don't really want to choose - who wants to go into treatment for a condition that we hate to admit we need help with? Or even that we have? Or that works so well in some ways! Not many of us.

Given that we may not want to admit that we need help, don't really want help, and that we're probably only looking in order to placate our family or employer or the courts, how are we going to decide what to sign up for? And even if we do really, secretly, know we need some help with this, how are we to pick a program or office or counselor or other professional?

There are a lot of choices.

Most of us avoid seeking professional help for messy situations. Things have to be pretty bad before we head off to the divorce or bankruptcy lawyer, the doctor, the dentist and so on. When we do we frequently get names from friends and colleagues who liked this doctor or got this great settlement and so on. But no one talks about, or asks about, their alcohol problems and solutions. You're pretty much stuck with late nights searching Internet or thumbing through the Yellow Pages. That being the case, you'd better do some preparation before you start making those phone calls.

Looking through ads, whether electronic or print, will tell you a few things about program philosophy. Generally the possibilities will come down to two: services that are modeled on AA, and those that aren't. Ninety percent are in the first category, the so-called 12 Step programs. If you have been to AA and been comfortable with that format then you may prefer to continue with that model. If you haven't been to any AA meetings this might be a good time to go - it's free, it's convenient, and it'll answer a lot of your questions in a hurry at no expense. You may find that it works for you and you can stop looking. That happens for roughly ten percent of those who try AA.

If you are comfortable with the AA approach, but still need more help, then you can start looking at program philosophies, staffing, duration, and services. That's a lot to sort through when you're in distress. You can shorten the process with a few key questions:

What is your success rate? In fact, no program knows. Anyone who claims to know is misleading you.

Are any of your staff former clients? Competent and confident programs do not hire former clients. Nor do successful clients need to stay attached to "their programs" to maintain their progress.

How many of the staff identify themselves as "recovering?" The real world is not made up of "recovering" people and that's the world you want to live in. A program that's merely an extension of treatment for staff members isn't going to help you prepare to leave alcohol behind.

If traditional AA meetings don't help you, then you can probably decide with some certainly that 12 Step based programs aren't going to either. That being the case you can sort through the tiny number of "non-12-Step" possibilities using the same questions.

Assuming you receive satisfactory answers, you can add a few more questions. If they don't use a 12-Step basis, what do they use? Generally, they will be based on you and your unique circumstances and needs.

Additionally, good programs, AA anchored or not, will have physical and medical components; may work with anti-craving medications such as Naltrexone; use Cognitive Behavioral Therapy (CBT) for related and underlying problems; offer complete confidentiality; and are unlikely to accept insurance (which is rarely available in any case and seriously compromise confidentiality when it does exist).

Finally, good service providers will begin with an intensive involvement that tapers down over a year. Behavioral change is difficult and takes time, thirty to ninety days of focused work on all aspects of your life, followed by decreasing structure as you resume control over your life. A good program, like a good counselor, is interested in becoming obsolete.

Take what time you can afford and choose carefully. If the muddle, distress, and confusion is too much, and it frequently will be, find a friend you trust who doesn't have a vested interest in the outcome to help you reach a decision. Listen to them.